title: Intradermal proximal field block: an innovative anesthetic technique for levonorgestrel implant removal.
abstract: BACKGROUND
  Levonorgestrel implant removal is a common office procedure. These procedures can be difficult and uncomfortable for the woman. Many removal techniques use only small amounts of lidocaine to diminish tissue distortion and to allow palpation of the implants. We report an alternative technique that can maximize the anesthesia during removal procedures.
  
  
  METHODS
  Using the "ice saline" technique, lidocaine is infiltrated proximal to the implant tips, creating a field block of the superficial medial antebrachial cutaneous nerves and anesthetizing the operative site without injecting lidocaine around the implants.
  
  
  RESULTS
  We began using this technique 3 years ago and have used it for more than 50 removals. There have been no complications, and the block appears to reduce the pain reported.
  
  
  CONCLUSIONS
  The proximal intradermal field block is an alternative anesthetic technique for levonorgestrel implant removal.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington and Harborview Medical Center, Seattle 98104-2499, USA. lmiller@u.washington.edu
authors.forename: L
authors.initials: L
authors.lastname: Miller
authors.forename: J
authors.initials: J
authors.lastname: Grice
mesh_terms: D000779:Anesthetics, Local; D001132:Arm; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004343:Drug Implants; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage*; D008012:Lidocaine; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D012867:Skin / Q000294:innervation
chemical_list: D000779:Anesthetics, Local; D003271:Contraceptive Agents, Female; D004343:Drug Implants; D016912:Levonorgestrel; D008012:Lidocaine